Functional Medicine is an emerging specialty which considers ‘dysfunction’ of cellular physiology and biochemistry as the cause of chronic conditions and aims to restore function. Patients are more frequently turning towards this form of medicine, as they recognize that much orthodox prescribing is based on placating symptoms with little focus on cure or treatment of underlying cause.
When any such therapy is offered by conventionally trained doctors, who may also concurrently prescribe orthodox medicine, the term Integrated (or Integrative) Medicine (IM) is now used.
IM medicine is a mixture of conventional with Complementary and Alternative medicine (CAM).
In 2010 a study by Hunt KJ et al showed data from 7630 respondents in the UK.
- 12.1% of those asked had seen and consulted a practitioner in the preceding 12 months.
- 29% had been taking prescription drugs and had used CAM alongside in the previous 12 months.
There are many reasons for the popularity of CAM therapies and it is not just the public who seem to be showing an interest. A Californian study in 2015 has shown 75% of 1,770 USA medical students ‘think it would be beneficial for conventional Western medicine to integrate with complementary and alternative medicine (CAM)’.1
As global health systems feel the pressure of increasing costs, the sensibility of combining some Integrated Medicine into national health care seems logical and has been proven as viable. The budget for the NHS in England for 2016/17 is £120 billion. This is forecast to rise by nearly £35 billion in cash terms – an increase of 35% by 2021. Treating people with chronic diseases may account for 86% of our nation’s health care costs based on USA figures.2Arguably this makes the cost of care, using the current model, economically unsustainable. We need to find ways of changing this slide to affordability.
There are a number of studies suggesting that CAM may reduce medical expenditure and costs3 but others, based on the current paradigm of orthodox medicine, that do not.
In 2008 the UK annual spend on alternative health treatments was £4.5 billion, a market that has grown by nearly 50% in the last decade.4 This increasing expense would be surprising if people were not actually benefiting and may reduce the current increasing expenditure if it keeps patients away from General Practice and hospitals.
Doctors and academics see benefit in better understanding of CAM use by their patients and establishing what is and isn’t working5, yet there continues to be concerted attacks on CAM with authorities not caring to take a balanced view of the evidence and calling it a waste of resources. Unfortunately, lack of finances means a broad defence has yet to be established and studies struggle to be funded.
‘A lack of evidence is not evidence of a lack of efficacy’
Most detractors of IM will argue there is a lack of published evidence to prove the efficacy of CAM and it is generally agreed that too few studies on CAM/IM are initiated and concluded. This is a financial issue as complementary practitioners and centres do not have the necessary funds to publish large studies.
Yet there is an astonishing amount of peer-reviewed, published scientific evidence behind a myriad of naturopathic therapies, but many studies are small and outcomes not repeated frequently due to funding issues. We must not allow a lack of evidence to reflect a lack of efficacy.
It is a sad scenario that despite peer-reviewed and published papers calling for UK curriculum coordinators to improve CAM teaching, there is little movement within medical schools to do so.
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Author(s): Dr Rajendra Sharma